What antibiotic is effective for treating acute sinusitis?

From the Guidelines

Amoxicillin-clavulanate is the preferred antibiotic for acute bacterial rhinosinusitis (ABRS) in adults, according to the American College of Physicians and the Centers for Disease Control and Prevention 1. When managing sinus infections, it's essential to consider the potential benefits and harms of antibiotic treatment.

• Most patients with acute rhinosinusitis have more adverse effects than benefits from antibiotics, with a number needed to treat of 18 for 1 patient to be cured rapidly, but a number needed to harm of 8 due to adverse effects from antibiotics 1.
• The American Academy of Otolaryngology–Head and Neck Surgery recommends watchful waiting as initial management for all patients with uncomplicated ABRS, regardless of severity 1.
• Amoxicillin-clavulanate is the preferred agent, and doxycycline or a respiratory fluoroquinolone may be used as an alternative in patients with ABRS 1.
• Adjunctive therapy, such as intranasal saline irrigation or intranasal corticosteroids, has been shown to alleviate symptoms and potentially decrease antibiotic use 1.
• Patients who are seriously ill, who deteriorate clinically despite antibiotic therapy, or who have recurrent episodes should be referred to a specialist 1. In terms of treatment,
• amoxicillin-clavulanate (875/125mg twice daily) may be prescribed for 5-10 days for patients with ABRS 1.
• For patients with penicillin allergies, alternatives include doxycycline (100mg twice daily) or trimethoprim-sulfamethoxazole (one double-strength tablet twice daily). It's crucial to note that most sinus infections are viral and will resolve without antibiotics, so these medications are typically reserved for symptoms lasting longer than 10 days, severe symptoms, or worsening symptoms after initial improvement. While taking antibiotics, staying hydrated, using saline nasal irrigation, and taking over-the-counter pain relievers can help manage symptoms. Antibiotics work by either killing bacteria or preventing their reproduction, allowing your immune system to clear the infection more effectively. Complete the full course of antibiotics even if symptoms improve to prevent recurrence and antibiotic resistance.

From the FDA Drug Label

1.4 Acute Bacterial Sinusitis: 5 Day and 10 to 14 Day Treatment Regimens Levofloxacin tablets are indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis [see Clinical Studies (14.4)]. To evaluate the safety and efficacy of a high dose short course of levofloxacin, 780 outpatient adults with clinically and radiologically determined acute bacterial sinusitis were evaluated in a double-blind, randomized, prospective, multicenter study comparing levofloxacin 750 mg by mouth once daily for five days to levofloxacin 500 mg by mouth once daily for 10 days Clinical success rates (defined as complete or partial resolution of the pre-treatment signs and symptoms of ABS to such an extent that no further antibiotic treatment was deemed necessary) in the microbiologically evaluable population were 91.4% (139/152) in the levofloxacin 750 mg group and 88.6% (132/149) in the levofloxacin 500 mg group at the test-of-cure (TOC) visit

• Levofloxacin is indicated for the treatment of acute bacterial sinusitis due to Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis.
• The recommended treatment regimens are 750 mg by mouth once daily for 5 days or 500 mg by mouth once daily for 10 to 14 days.
• Clinical success rates were 91.4% in the levofloxacin 750 mg group and 88.6% in the levofloxacin 500 mg group at the test-of-cure visit 2 2.

From the Research

Antibiotic Treatment for Sinus Infection

• The use of antibiotics for sinus infections is a common practice, but the effectiveness of different antibiotics can vary [ 3 , 4 ].
• Studies have shown that amoxicillin with clavulanate is a commonly recommended treatment for acute bacterial sinusitis [ 3 , 5 ].
• High-dose amoxicillin may be more effective than standard-dose amoxicillin in some cases, but the evidence is not consistent [ 3 , 4 ].
• Other antibiotics, such as cefuroxime, cefpodoxime, and cefdinir, may also be effective for treating sinus infections [ 5 , 6 ].
• The choice of antibiotic should be based on the severity of symptoms, the presence of allergies or resistance, and the potential for side effects [ 5 , 6 ].

Considerations for Antibiotic Use

• Antibiotics should only be used for bacterial sinus infections, as they are not effective against viral infections [ 6 , 7 ].
• The use of antibiotics can have side effects, such as diarrhea, and can contribute to antibiotic resistance [ 3 , 4 ].
• Supportive care, such as saline irrigation and nasal steroids, can help reduce symptoms and may be used in conjunction with antibiotics [ 6 ].